- Highmark Health (Frankfort, KY)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Humana (Frankfort, KY)
- …reports to the Lead Medical Director . **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Frankfort, KY)
- …reports to the Lead Medical Director .** **Other duties:** + Identify medical management operational improvements, including those within the medical ... part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home… more
- Humana (Frankfort, KY)
- …a Lead Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Evolent (Frankfort, KY)
- …accountability for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- CenterWell (Frankfort, KY)
- …Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization review of the care ... **Become a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health… more
- Humana (Frankfort, KY)
- …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The … more
- Humana (Frankfort, KY)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The … more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals ... (Part D & B). The Medical director work assignments involve moderately complex...or clinical group practice management + Utilization management experience in a medical management… more
- Humana (Frankfort, KY)
- … medical management operational improvements, including those within the medical director area + Participate in call rotation + Develop collaborative ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Merck (Frankfort, KY)
- …high-priority objectives. Internal strategic excellence: In coordination with those in Executive Director Medical Affairs (EDMA), Global Director Medical ... **Job Description** **Role Summary** The Global Medical Excellence Director (GMED) reports to the Sr. Director , Global Medical Excellence, and is an… more
- HCA Healthcare (Frankfort, KY)
- …or limits? Our Frankfort Regional Medical Center team is looking for a Medical Surgical Nurse Director . HCA Healthcare is an advanced healthcare network that ... innovation of ideas. **Job Summary and Qualifications** The Med/Surg Director assists the CNO in executive-level management ...colleagues and communities. Help guide our team as a Medical Surgical Nurse Director and help us… more
- Merck (Frankfort, KY)
- …partnership with Precision Medicine Health Systems Oncology Medical Affairs Director (PM HSO-MADs), oncology account management , and precision medicine teams ... This role also serves as a resource for the Medical Affairs (MA) management team on strategic...resource for the PM MAD-HSO Team Lead, HSO Executive Director Medical Affairs, and other members of… more
- Evolent (Frankfort, KY)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... utilization management while working in conjunction with the Senior Medical Director . **Qualifications** + MD/DO/MBBS Degree + Current, unrestricted clinical… more
- Evolent (Frankfort, KY)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS Degree + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Evolent (Frankfort, KY)
- …for utilization management while working in conjunction with the Senior Medical Director . **Qualifications - Required and Preferred:** + MD/DO/MBBS- Required ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key...Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On… more
- Parexel (Frankfort, KY)
- …we are expanding our esteemed Medical Sciences Team and seeking an Associate/ Medical Director to support the growth of our Global Immunology and Inflammation ... Therapeutic Franchise. As an Associate / Medical Director , you will work closely with...protocol Note that this does not include any direct medical advice on patient care or management … more
- Molina Healthcare (Lexington, KY)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- Evolent (Frankfort, KY)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization ... is recorded in a timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management … more